Can Blood Culture Contamination Cloud Fungal Positivity?

Year 2023, , 61 - 65, 15.03.2023

Ali Korhan Sığ , Gülhadiye Avcu , Basak Yildiz Atikan , Mustafa Güney

https://doi.org/10.53424/balikesirsbd.1201884

Abstract

ABSTRACT
Objective: Blood culture (BC) is gold standard for diagnosis of fungemia. Contamination of BC is a major problem worldwide, since it may delay actual diagnosis. The aim of this study was to evaluate “contaminant” vials with a prolonged incubation (max 30 days) with antimicrobial supplemented media to observe any mycological growth. Materials and Methods: Routine BCs obtained patients of Balıkesir Atatürk City Hospital for a year period were included. Render BC System BC12-8 (Render Biotech Co. Ltd., Shenzhen, China) were used. Contaminated vials were re-incubated and conventionally inoculated weekly for four weeks total. In case of any growth, identifications were done by PhoenixTM 100 system (Becton Dickinson, MA, USA) with cornmeal tween 80 agar (RTA Laboratories, Kocaeli, Türkiye). Antifungal susceptibility testing was applied with CLSI disk diffusion method. Results: 3.9% (235 sets and additional 138 vials) of total 6047 BC sets (23.06% positive) were contaminated. Only one vial from central venous catheter showed fungal growth within the first week of conventional inoculation (>8th day of total incubation). The isolate was identified as Candida guilliermondii complex and susceptible to caspofungin. Latter set of this patient were positive for the same fungi in the 3rd day of incubation. Conclusion: International guidelines recommend <3% contamination rate. In this study, our single strain was isolated from catheter vial with prolonged incubation and following set was routinely positive for the same fungi. For optimal isolation at least 2 following sets were required and thus, prolonged incubation was not beneficial. It was found that strict following of the rule of “2 following sets" was enough for optimal isolation of fungemia agent.

Keywords

invasive fungal infections, bloodstream infectons, fungi, Candida, invazif fungal enfeksiyonlar, kan dolaşımı enfeksiyonları, kontaminasyon

Thanks

The authors wish to declare special thanks to Muradiye YARAR, M.D., İlkay BOZDAĞ, M.D., Onur IRMAK, M.D., Alev ÇETİN-DURAN, M.D. and Osman KILINÇ, M.D. (Atatürk City Hospital, Department of Medical Microbiology, Balikesir, Turkey) for their precious support.

Kontamine Kan Kültürleri Fungal Pozitifliği Gölgeleyebilir Mi?

Abstract

Amaç: Kan kültürü kontaminasyonu dünyada ciddi bir sorundur ve kan dolaşımı enfeksiyonu tanısını geciktirebilmektedir. Bu çalışmanın amacı, kontamine şişelerin uzatılmış inkübasyonu ile mikolojik üreme elde edilip edilemeyeceğinin araştırılmasıdır. Gereç ve Yöntem: Balıkesir Atatürk Şehir Hastanesi’nde bir yıl boyunca erişkin hastaların kan kültürleri Render BC128 Sistemiyle (Render Biotech Co. Ltd., Çin) çalışmaya alındı. Kontamine kan kültürü şişelerinin inkübasyonu geleneksel yöntemlerle haftalık ekilerek 30 güne tamamlandı. Üremelere PhoenixTM 100 sistemi (Becton Dickinson, ABD) ve mısır unu tween 80 agar (RTA Laboratories, Türkiye) ile tanımlama, CLSI disk difüzyon ile antifungal duyarlılık yapıldı. Bulgular: Toplam yıllık 6047 kan kültürü seti (%23.06 pozitif) işlendi ve bunların %3.9’u (235 set ve ek 138 şişe) kontamineydi. Sadece santral venöz kateterden alınan bir şişede anlamlı fungal üreme oldu (toplam inkübasyonun 8. Gününden sonra). Kaspofungine duyarlı Candida guilliermondii kompleks olarak tespit edildi. Bu hastanın takip eden ikinci seti 3’üncü gün pozitif sinyal verdi. Sonuç: Uluslararası rehberler, kontaminasyonu <%3 olarak önermektedir. Bu çalışmada, kateterden alınan kan kültürü şişesinde uzatılmış inkübasyonla fungal üreme oldu ve takip eden set aynı mikroorganizma için rutin inkübasyonda pozitifti. Optimal izolasyon için en az 2 takip eden set alınması gerektiğinden, kontaminasyon tanıyı geciktirmedi ve kontamine şişelerin uzatılmış inkübasyonu fayda sağlamadı. “2 takip eden set” kuralına uyum ile optimal düzeyde fungemi etkeninin izole edilebileceği sonucuna varıldı.

Keywords

Candida, invazif fungal enfeksiyonlar, kan dolaşımı enfeksiyonları, kontaminasyon

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